AB0268 SURVEY OF ELDERLY RHEUMATOID ARTHRITIS (RA) PATIENTS: REAL-WORLD DATA OF PRE-OLD (65 TO 74 YEARS) AND OLD (≥ 75 YEARS) RA PATIENTS
Authors: A. Nakashima, H. Fujii, T. Suda, I. Mizushima, M. Kawano, H. Nomura
Journal: Annals of the Rheumatic Diseases (2022)

Background The number of patients (pts) with rheumatoid arthritis (RA) is highest in persons in their late 60s, and the age at onset has increased in recent years. In many countries, including Japan, ‘elderly’ is defined as 65 years or older, but recently, the Japan Geriatrics Society and Japan Gerontological Society have advocated a newer classification of elderly: pre-old as 65 to 74 years, old as 75-89 years and super old as ≥90 years 1) . Disease activities, renal functions, treatments and other parameters in thus classified elderly RA pts have not been investigated yet. Objectives Elderly pts with RA were classified, and then disease activities, treatments, renal functions and other parameters compared between the groups to clarify the real-world picture of pre-old and old RA pts. Methods We enrolled 359 RA patients (85 males, mean age 65.0 ± 13.6 years) treated at our hospital and affiliated hospitals. They were divided into three groups: under 65 years as a control group, 65-74 years as a pre-old (group I), and 75 years or older as an old (group II). Urine examination, serum Cr, eGFR, BUN, other biochemical tests, serological tests, disease activity, treatment, smoking, and comorbidities were evaluated. Difficult-to-treat RA pts (D2T RA) were evaluated according to EULAR criteria 2) . Results Group C contained 148 pts (28 males, mean age 51.7 ± 9.6 years), Group I 123 pts (28 males, mean age 70.1 ± 2.9 years) and Group II 88 pts (29 males, average age 80.2 ± 4.5 years). Among the three groups, the frequency of males was 33.0% in group II, which was significantly higher than in the other groups. There was no significant difference in disease activity among the three groups. There was a significant difference in eGFR among the three groups (77.3 ± 17.3 ml/min. in group C, 69.4 ± 15.8 ml/min. in group I, 62.7 ± 18.7 ml/min. in group II). There was a significant difference in frequencies of treatment with NSAIDs (40/133 (30.0%) in group C, 23/102 (22.5%) in group I, 9/67 (13.4%) in group II), methotrexate (MTX) (87/148 (58.8%) in Group C, 62/123 (50.4%) in Group I, 28/88 (31.4%) in Group II). There was no significant difference in frequencies of treatment with prednisolone (55 / 148 (30.2%) in group C, 55/123 (43.1%) in Group I, 45/88 (51.1%) in Group II), with biologics (44/148 (29.7%) in Group C, 29/123 (23.6%) in Group I, 26/88 (29.5%) in Group II) and with JAK inhibitor (15/148 (10.1%) in Group C, 7/123 (5.7%) in Group I, 5/88 (5.7%) in Group II). There was no significant difference in D2TRA pts among the three groups (21/148 (14.2%) in Group C, 12/123 (9.8%) in Group I, 13/88 (14.8%) in Group II). There were significant differences in the frequency of stage IV and comorbidities among the three groups. Conclusion In the pre-old and old RA pts, renal function was lower than in the control group. MTX was administered even in them, but less frequently. We were able to clarify the current situation that JAK inhibitors and biologics are actively used even in pre-old and old RA pts with impaired renal function, and the frequency of D2T RA pts could be suppressed to almost that in the control group. Patients with impaired renal function are more likely to develop side effects of MTX, and it is necessary to pay particular attention to pre-old and old RA patients. References [1] Ouchi, Y., Rakugi, H., Arai, H., Akishita, M., Ito, H., Toba, K. et al. (2017). Redefining the elderly as aged 75 years and older: Proposal from the Joint Committee of Japan Gerontological Society and the Japan Geriatrics Society. Geriatr Gerontol Int, 17(7), 1045-1047. [2] Nagy, G., Roodenrijs, N. M. T., Welsing, P. M., Kedves, M., Hamar, A., van der Goes, M. C. et al. (2021). EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis, 80(1), 31-35. Disclosure of Interests None declared